Today’s guest blogger is Jennifer Mullen.  Jennifer is a  certified optometric vision therapist at Eyecare Professionals P.C. and The Tannen Center for Vision Development with Dr. Barry Tannen in New Jersey. This article also appears in Visions, which is COVD’s newsletter. 

When my oldest son started pre-school, I was a nervous first time mom.  I had the good fortune to have a conference with an experienced pre-school educator.  When I sat down for the conference, she had three tomatoes sitting on her desk.  One was completely red and ripe, one was that sort of pale orange of a tomato just starting to ripen, and one was green.  We had our conference and I found out my son was doing fine (whew!).   When I asked if the tomatoes were part of a project the kids were doing, she explained that she always puts them out for the first conference because so many parents worry about how their children are developing.  She told me, “These tomatoes are from the same plant, picked at the same time, but regardless of how they look now, someday they all will be red.”  From that day forward I always think of that when I begin to worry about my children in comparison to someone else.  I also have applied it as an important lesson that we as therapists can remember when working with our patients.

Over the years I cannot count the number of times I have had patients with the exact same diagnosis, prescribed the same amount of sessions, progress in very different ways. For instance, two patients are both diagnosed with a convergence insufficiency but by session 6 one of them can converge to the nose with effort, while the other is still struggling to converge at 8 inches.  When I first started working as a vision therapist, I spent countless hours riddled with anxiety over this.  Why wasn’t the other patient progressing?  Why weren’t the same therapy techniques working and accomplishing  the same thing in the same amount of sessions?  How would the patient that was having trouble ever be done with VT at this rate of progress?  One of the things that helped calm me down was to think of the patient that progresses a bit more slowly as a green tomato.  The other was to realize that as a therapist, it was my job to figure out what I needed to do a little differently to get that tomato to turn red!

When we get a new patient, we are usually handed a pile of testing that tells us what a patient CANNOT do.  He can’t converge, he can’t track, he can’t reproduce a picture, he can’t find a picture hidden among other things, he can’t remember what he sees, etc., etc.  As therapists we need to figure out what each patient CAN do and start from there.   This involves a lot of listening and observation on our part.  Often it is a little bit like searching for clues and solving a mystery, but that’s one of the things that makes vision therapy always interesting.  All of our patients are like a jigsaw puzzle; we have to find the pieces and figure out how they go together, but it’s never the same.  For instance, we had a patient in our office diagnosed with  convergence insufficiency.  Her near point of convergence at her initial evaluation was 24 inches.  So obviously her “can’t” was convergence.  We started treating her, and no matter what we did, she could not converge.  One of the most unusual things about this patient was she loved to read, and in spite of her CI she was an avid reader.  During therapy I chatted with her about this.  I asked if she ever saw double during reading, she told me no, never.  So here’s where the mystery really kicks in, because in all of our therapy sessions, whenever we did binocular tasks, she never suppressed either.  How on earth was she reading without seeing double?!  I asked her to show me how she usually reads at home.  She took the book, put it in her lap, looked down at it and started to read.  Ah ha!  She could converge a little in down gaze!  From that point on we started training convergence in down gaze, and then slowly worked into primary gaze.  By the end of therapy, she could converge with good control.  The green tomato turned red!

Albert Einstein said, “Everybody is a genius. But if you judge a fish by its ability to climb a tree, it will live its whole life believing that it is stupid.”  All of our patients have different learning styles, different abilities, and different experiences.  We need to find out about all of these and use them to best serve our patients.